Provider Demographics
NPI:1730334053
Name:FERRIS, TERESA DOROTHY
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:DOROTHY
Last Name:FERRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TERRI
Other - Middle Name:
Other - Last Name:FERRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:599 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1244
Mailing Address - Country:US
Mailing Address - Phone:978-686-8202
Mailing Address - Fax:
Practice Address - Street 1:39 COX LN
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-1732
Practice Address - Country:US
Practice Address - Phone:978-686-1456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204715363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health